Fri May 9, 2014

Midwifery: A Profession Of Passion, For Men Too

Mother's Day is coming up. And as we look ahead to that, let's take a moment to think about how millions of us came into the world - that is to say with the help of midwives, the women, and sometimes the men, who help women through the birthing process. In many places, midwives are the only assistance expectant mothers receive. And now there may be a global midwife shortage. A 2011 report by Save the Children warned that a lack of midwives in the developing world meant that tens of thousands of women and babies were at risk of dying in childbirth.

Today we want to hear two perspectives on this ancient profession. Esther Madudu is a midwife from Uganda. She is the face of the global campaign Stand up for African Mothers. It is an effort from AMREF, a health organization that aims to train 15,000 African midwives by 2015. Welcome. Thank you so much for coming.

ESTHER MADUDU: Thank you.

MARTIN: And for additional perspective, we also have with Ebony Roebuck. She is a certified nurse midwife, based right here Washington, D.C. Thank you so much for coming.

EBONY ROEBUCK: Thank you.

MARTIN: We wanted to hear more about their work and how it can differ on different continents. So, Ebony, I'm going to start with you because midwives used to play the same kind of role in the birthing process in the U.S. that they played, you know, elsewhere in the world. But they don't seem to be as central to the process now, you know, in the U.S. They are still the choice of many mothers who are very passionate about it. And I just - so I wanted to ask if you could describe for people who aren't familiar with your practice what role you play. Are you the primary sort of birth coach? What do you do?

ROEBUCK: Yeah. So midwifery now - I know some people always kind of think that I'm a secret, undercover circus or animal trainer. But we take care of women throughout the lifespan. We do GYN care. We do OB prenatal. We deliver. We also do postpartum, and we also take care of women all the way through menopause. So a typical office, I see everything from contraception to an annual to prenatal visit.

MARTIN: And what's a typical day for you, very briefly?

ROEBUCK: So a typical day, if I'm in the office, I see maybe, like, 15 to 20 patients. Or if I'm on the labor floor, I am taking care of women in labor and trying to catch babies.

MARTIN: OK. So, Esther, what about you? Does that sound familiar?

MADUDU: Yeah, it is familiar because a midwife is a midwife. We do the same things. But, you know, midwifery in Africa is something very different from the U.S. because one midwife has a 24-hour commitment. Mothers come to her at any time.

MARTIN: You know, the AMREF is actually campaigning for your nomination for next year's Nobel Peace Prize to recognize the work of midwives who work in challenging circumstances. But I did want to ask for people who are not familiar about some of the challenges that perhaps are invisible to people who don't do the work that you do.

MADUDU: The challenges I face mostly is - you can imagine a mother walking seven, 20 kilometers to the health facility maybe with bleeding. That mother can die. And that trauma comes to the midwife. You feel it that I wish I was there. I wish this mother was in the health facility.

And the challenge again is you want to help a mother. But you find that there's nothing you use, you know. There's no drug to save this frustration. And worst of all, or the best of all, a midwife, if she's trained, she's a small doctor in a small scale because she's available 24/7. And she's so simple, easy to approach her than as in Africa seeing a doctor is very expensive. And if this midwife is trained, she's able to take care of over 500 mothers per year and conduct labors of about a hundred babies per year. And you find it's something very simple, and a woman easily walks in to approach a midwife than approaching the doctor.

MARTIN: What drew you to this work?

MADUDU: It's a good story because I got it from my grandmother who happened to be a birth attendant. I was a little girl about 6 or 7 years. I could see mothers who were coming to her house with a big abdomen. And I was such an inquisitive girl to ask what they ate so that the abdomen became so big and extended. So over...

MARTIN: What did they eat?

MADUDU: Yeah, what are they eating? So...

MARTIN: Well, in this country we would say a watermelon, of course.

MADUDU: Yeah.

MARTIN: Swallowed a watermelon seed.

MADUDU: Yeah, and one day she let me in, and said, Esther, come and see what is coming out of the big abdomen. So she was conducting a delivery. I witnessed a delivery and I asked her who taught you how to do that? She said me. I'm using my natural knowledge. For you, when you grow up, go to school. That was her caution to me that you go to school and you'll become a nurse.

So for me, I'm using my natural knowledge. So I grew up with that vision and that passion. I said I must be that person who can help women. I must do this one. That's how I became a midwife.

MARTIN: Oh, wow.

MADUDU: Yeah.

MARTIN: That's amazing. Wow. Ebony, what about you? How were you drawn to this work? Why did you want to be a midwife?

ROEBUCK: I actually was always fascinated with pregnancy and birth. Anybody in my family that was pregnant, I was like their little birth assistant - whether it be, like, errands or going to get them food. And I actually went to school to be an obstetrician, and then ended up with a psych degree 'cause it was safer and then met a midwife.

MARTIN: What do you mean safer?

ROEBUCK: Well, I - you know, I was probably the first in my family to go to school. And I got I thought was horrible grades, but they were not horrible. But I was scared, and I didn't have, maybe, better mentorship. And so the psych department recruited me, and so I got a psych degree.

But I went for an annual - and, you know, usually when you go for an annual, you're undressed. And I walked in and she said don't take off your clothes. And, like, sat me down and did, like, a really detailed history and asked me questions nobody had ever asked me. And she was teaching me stuff about my body.

And I was like, well, - I was like this is very different. I've never had an annual like this, you know, and I'm a grown woman. And she said 'cause I'm a midwife. Because a lot of people focus on midwifery just thinking that it's only related to birth. But midwifery is about women empowerment. It's about education. And our relationships with the mothers and women is a lot more intimate. And so I just fell in love. Best decision ever.

MARTIN: That's wonderful. If you're just joining us, we are learning more about the lives and work of two midwives. Ebony Roebuck, that's who was speaking just now, who practices in Washington, D.C. and Esther Madudu who's with us from Uganda.

Esther, we are learning, as I understand, that there is a shortage of midwives. Is part of the issue, though - I was wondering in part about the lifestyle, though. You were telling us it's a 24-hour commitment. You know, we have the same issue here...

MADUDU: Yeah.

MARTIN: ...Getting medical personnel in underserved areas. Is it - a lot of people say I don't want to be on call 24 hours a day. And I just wonder if that's part of it.

MADUDU: But, you know, if you're motivated, you do your work very happily, and you can do without any complaints, you know. In my country, midwives, they're having the passion to do their work, not for money, not for anything because they feel it, you know. Like me now, I'm here. I'm missing touching the abdomen because I love it...

ROEBUCK: Right.

MADUDU: ...And I like it. And, you know, midwifery is hands on, you know, hands on. It's practice. When you miss midwifery skills for a month, you have to begin afresh.

MARTIN: I understand that there's an effort also to get more men interested in this field. Is this true?

MADUDU: Yeah. Yeah, yeah, yeah.

MARTIN: Is that happening?

MADUDU: It's one of the AMREF's initiatives, objectives in this campaign of Stand up for African Mothers because we are trying to involve men in the - productive help. I'm very happy to say that men are now coming up to do midwifery and...

MARTIN: Men are involving in midwifery?

MADUDU: Yes, yes, yes, yes because in most of our countries, men used to fear, you know, doing that. But now boys are coming and they're doing very well.

MARTIN: We researched this question. And in 2012, there were around 13,000 certified nurse midwives in the U.S., which is a pretty small group given how big this country is and how many women are of age to have babies. And I'm just - do you see - what do you see? I mean, is it that - why do people seek out a nurse midwife experience as opposed to, say, a doctor or some other birthing experience? And do you see a desire to grow this profession?

ROEBUCK: Definitely, definitely. I think that more women, like I said, are becoming birth consumers. They want more of a say. They want more options. They want less interventions because I think that birth has moved definitively towards having more interventions. And I think women are seeking out the opportunity to have more time. I think women are looking for the intimacy. I always make the joke that midwives hug their patients.

There are also another surge of women that are looking for unmedicated births. You know, we're all in this green lifestyle, organic, and you have more women looking for the opportunity to birth without medication. And we are the specialists. You know, we're not surgeons, but I can definitely labor you unmedicated. And that's its own skill set. Women just want more options and so they're coming to us, flocking to us pretty heavily.

MARTIN: Well, thank you for your work. Thank you for your work.

MADUDU: You're welcome.

MARTIN: Esther Madudu is a midwife from Northeast Uganda. She's the face of an AMREF's global campaign - Stand up for African Mothers. She was kind enough to join us here in our Washington, D.C. studios along with Ebony Roebuck who's a certified nurse midwife based here in Washington, D.C. And they're spending some time together and were nice enough to take some time out to spend with us. Thank you both so much for joining us.